Provider Demographics
NPI:1437187952
Name:DILLON, MARY CATHERINE
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:CATHERINE
Last Name:DILLON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5830 MERIDIAN RD
Mailing Address - Street 2:
Mailing Address - City:GIBSONIA
Mailing Address - State:PA
Mailing Address - Zip Code:15044-9605
Mailing Address - Country:US
Mailing Address - Phone:724-443-0800
Mailing Address - Fax:
Practice Address - Street 1:5830 MERIDIAN RD
Practice Address - Street 2:
Practice Address - City:GIBSONIA
Practice Address - State:PA
Practice Address - Zip Code:15044-9605
Practice Address - Country:US
Practice Address - Phone:724-443-0800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS007122L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012821910003Medicaid
001246483016OtherUNITED HEALTHCARE
721368OtherHIGHMARK BLUE SHIELD
P00235012OtherRAILROAD MEDICARE
0558639000OtherINDEPDENCE BLUE SHIELD
400552OtherHEALTH AMERICA
102883OtherUPMC HEALTH PLAN
1535276OtherGATEWAY HEALTH PLAN
4246275OtherAETNA
PA0012821910003Medicaid
0558639000OtherINDEPDENCE BLUE SHIELD